Fellowship training in endourology: Impact on percutaneous nephrolithotomy access patterns

Area of Science:

• Urology
• Nephrolithotomy
• Surgical Access

Background:

• Percutaneous nephrolithotomy (PCNL) is the standard treatment for kidney stones exceeding 2 cm.
• Limited research exists on why urologists choose to perform their own PCNL access versus relying on interventional radiology (IR).

Purpose of the Study:

• To investigate the factors influencing the decision of whether urologists obtain their own percutaneous nephrolithotomy (PCNL) access.
• To understand practice trends and motivating factors among young urologists regarding PCNL access.

Main Methods:

• A survey was distributed to the American Urological Association's (AUA) Young Urologist Community.
• Descriptive statistics and exploratory analyses were employed to analyze practice trends and motivations.

Main Results:

• 47% of 92 practicing urologists performing PCNLs obtain their own access.
• Endourology fellowship training and logging over 50 cases during training predicted urologists obtaining their own access.
• The primary reason cited for obtaining own access was the preference for controlling the access point (95%).

Conclusions:

• Urologist-obtained PCNL access is linked to enhanced training and higher annual case volumes.
• Key factors influencing this decision include control of access, comfort, and convenience for both physician and patient.
• Addressing barriers and improving education can facilitate urologist-obtained PCNL access, potentially enhancing patient outcomes.